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SPEX Announcements


The SPEX ® is a computerized, multiple-choice examination of current knowledge requisite for the general, undifferentiated practice of medicine. The examination is used to re-examine a physician's ongoing level of basic medical knowledge and is intended for physicians who currently hold, or who have previously held, a valid, unrestricted license to practice medicine in the US or Canada. 

State boards may require SPEX for endorsement of licensure, reinstatement, or reactivation of a license after a period of inactivity. If the board has or is aware of concerns and/or questions about a physician's fitness to practice, SPEX results should be evaluated in conjunction with other available evidence to determine a physician's competence and fitness to practice. 

2019 SPEX 

A new, improved version of the SPEX was implemented on January 15, 2019. The changes made to SPEX help ensure that the exam continues to be relevant to current standards of practice.

Specific improvements made to SPEX include an update of the exam blueprint, an update of the item pool (i.e., new test forms and questions), and implementation of new item formats (e.g., drug ads and abstracts).

The exam was also shortened by 2.5 hours to better accommodate physicians’ busy schedules.

If you take the SPEX in 2019, you are responsible for reviewing the 2019 SPEX Information Bulletin prior to testing.


How is the new version of the SPEX different from the previous version?

Content: New item formats (e.g., drug ads and abstracts) were implemented. The new exam also contains fewer questions. The new version continues to focus primarily on tasks that physicians do in practice (i.e., patient management/care items) and less on mechanisms of disease items (i.e., disease applications relating to underlying basic sciences). 

Length: The length of the exam shortened by 2 ½ hours and contains fewer items.

Previous SPEX:  8½ hour exam with 336 items. Consisted of 7 blocks of 64 minutes each, with 48 items per block; plus break(s) and tutorial.

New SPEX:  6-hour exam with 200 items. Consists of 5 blocks of 60 minutes each, with 40 items per block; plus break(s) and tutorial.

Why were these changes made?

Best practices in testing require regular reviews and updates of the examination blueprint & item pool. The changes made to SPEX will ensure that the exam continues to be relevant to current standards of practice. 

When and where will the new version of the SPEX be available?

Testing under the new version of the SPEX began on January 15, 2019. (The previous version of the SPEX was only available through December 31, 2018.)

The SPEX program imposed a “blackout” time from January 1-14, 2019, to allow us to complete the transition to the new version of the SPEX with the Prometric testing centers.  No SPEX exams were available during this time.

The test is still administered at Prometric Testing Centers in the U.S. and Canada.


Have the eligibility requirements changed under the new version of the SPEX?

No. The exam is still designed and being used for the same purposes (i.e., to assess the ability to apply, at a minimally acceptable level, the general medical knowledge considered essential for continued, unsupervised medical practice).  Therefore, eligibility requirements remain the same depending on your category of application:

Board-sponsored: To be eligible to take the examination through the board-sponsored process, you must hold or have held a current, unrestricted license in a United States or Canadian jurisdiction and otherwise have met eligibility requirements established by the individual licensing boards pursuant to their statutory and regulatory provisions. If you need or wish to take the examination as a board-sponsored candidate, you should contact the licensing authority from which you plan to seek a license to ask whether there are additional eligibility requirements you must meet. The FSMB maintains contact information for all licensing boards on its website (

Self-nominated: To be eligible to take the examination through the self-nominated process, you must have a current, unrestricted license to practice medicine in a United States or Canadian jurisdiction.


What is the SPEX fee?

The SPEX fee is currently $1,300 and is paid online via credit card. The SPEX fee is non-refundable and non-transferable from one eligibility period to another or from one application to another.  If you schedule an examination but do not take it and do not cancel with Prometric, you will forfeit your entire SPEX fee. 

Any future changes to the SPEX fee will be announced on the FSMB website. 


What will be the passing standard for the new version of the SPEX?

The recommended minimum passing score of 75 will remain as is. However, medical licensing authorities may accept the recommended pass/fail result, or they may establish their own passing score.

Recommended performance standards for the SPEX are based on a specified level of proficiency. As a result, no predetermined percentage of examinees will pass or fail the examination. The recommended minimum passing level is reviewed periodically and may be adjusted at any time. It should be noted that the reported score of 75 is NOT “75%” but a value on a scale that meets the requirements of licensing board statutes and regulations.

When will scores be available for the new version of the SPEX?

Scores for examinees who tested January 2019 through late March 2019 were released April 11, 2019. SPEX scores are provided in a paper format and are mailed to examinees. The score delay was necessary for us to complete the quality assurance procedures for the new version of the exam.


What is the best way to prepare for the new version of the SPEX?

The most appropriate preparation for the SPEX is a well-planned and comprehensive review of up-to-date medical textbooks, clinical review publications, and periodicals.

FSMB offers a free paper and pencil practice test on its website. A link to the practice test is available at: (Scroll down to the “Preparing for your Exam section” of the page.)  (Open the question “What is the best way to prepare for the SPEX?”)

A web-based “self-assessment” – the Comprehensive Clinical Medicine Self-Assessment (CCMSA) – is also available. The CCMSA uses information typically covered in clinical encounters, and the content of the items resembles the content in SPEX. The CCMSA will help you become familiar with the question formats used in the examination and with how to maneuver within the examination before your actual test date. The CCMSA is available on the NBME website at

There are no test preparation courses affiliated with, or sanctioned by, the SPEX program.


What types of testing accommodations are available for individuals covered under the Americans with Disabilities Act (ADA)?

Reasonable accommodations are provided to examinees with documented disabilities as defined by the Americans with Disabilities Act as amended in 2008, together (“ADA”). If you are a disabled individual covered under the ADA and require test accommodations, visit before you apply for information regarding test accommodations, including procedures and documentation requirements.

Processing of test accommodations requests may take up to eight weeks from the date sufficient documentation is received. If your request is approved, special arrangements and procedures will be established and communicated to you by the National Board of Medical Examiners (NBME) Disability Services unit.

SPEX score reports and transcripts do not include an annotation that a test accommodation was granted.